HYDROmorphone Safety Self-Assessment
Instructions

1. It is recommended that the assessment be completed by an interdisciplinary team including at minimum:

one staff nurse

one staff pharmacist

one staff physician

Additional suggested team members:

quality improvement advisor/ patient safety officer/ risk manager

senior leadership representative

Because medication use is a complex, inter-disciplinary process, the value and accuracy of the self-assessment is significantly enhanced when it is completed by a broadly representative team rather than an individual clinician or discipline.

2. Distribute the self-assessment before the team meeting so that team members can review and consider the questions in advance. The copyright allows you to make copies of the self-assessment for internal use.

3. Complete the "Demographic Information" form.

4. Discuss each self-assessment item and evaluate the organization's current success in implementing items. As necessary, investigate and verify the level of implementation for each item with other healthcare practitioners outside the team.

A There has been no activity to implement this item

B This item has been discussed for possible implementation, but not implemented

C This item has been partially implemented in some or all areas of the organization

D This item is fully implemented in some areas of the organization

E This item is fully implemented throughout the organization

For self-assessment items with multiple components, full implementation (a score of D or E) is appropriate only if all components are present. If only one or some of the components have been partially or fully implemented throughout the organization, self-assessment scores should not exceed "C".

For self-assessment items with two distinct elements, each separated with the word "OR" and labelled (a) and (b), answer either part (a) or part (b), but not both.

The web-based survey tool will immediately download the information into a database maintained solely by ISMP Canada. No data is maintained on the Internet survey form after it has been submitted. Confidentiality is assured. The aggregate findings may be used by ISMP Canada for research and education purposes.

The web-based program will allow you to compare your results with those of other respondents. To protect the privacy of individual respondents, there must be at least 3 sites in the selected dataset to perform a comparison. Over time, you will be able to complete repeat assessments and compare your own results from one assessment to the next.